Abstract
Purpose
This study has two aims: determine the prevalence of CIN3 + in patients with discordant cotesting, defined as negative cytology and positive human papillomavirus (HPV) testing, and identify factors (including HPV strain) associated with CIN3 + , defined as cervical intraepithelial neoplasia (CIN) 3 or cancer within this population.
Methods
We conducted a retrospective chart review of women age 30–65 with intact cervices who had discordant cotesting results between January 1, 2013 and September 1, 2018, at an academic medical center. We used the t test for continuous variables and the Chi-square test for categorical variables to compare women with and without CIN3 + . To identify factors associated with CIN3 + , we performed univariate and multivariate logistic regression.
Results
The primary outcome was the prevalence of CIN3 + based on pathologic diagnosis following biopsy or excisional procedure. Among 375 patients with discordant co-testing, the mean age was 43.8 years, 58.4% were parous, and 84.8% were white. Overall, 43/375 (12.0%) had CIN3 + and 7/375 (1.9%) had AIS. On logistic regression, only parity ≥ 1 (p = 0.04, adjusted OR = 2.23, CI = 1.06–4.68) was significantly associated with CIN3 + . HPV-18 was less likely to be associated with CIN3 + (p = 0.02, adjusted OR 0.08, CI 0.01–0.65) but was present in 43% of AIS cases. HPV16 and other HR-HPV strains were highly associated with CIN3 + .
Conclusion
Women with discordant cotesting are at significant risk for CIN3 + . We recommend that biopsy be performed at the time of indicated colposcopy for all patients with discordant cotesting to assess for high-grade dysplasia.
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Data availability
Data can be made available upon request.
Code availability
Not applicable.
Abbreviations
- AIS:
-
Adenocarcinoma in situ
- ASCCP:
-
American Society for Colposcopy and Cervical Pathology
- ASCUS:
-
Atypical squamous cells of undetermined significance
- ASC:
-
Atypical squamous cells
- BMI:
-
Body mass index
- CIN:
-
Cervical intraepithelial neoplasia
- CKC:
-
Cold knife conization
- CPT:
-
Current Procedural Terminology
- HPV:
-
Human papillomavirus
- HR-HPV:
-
High-risk Human papillomavirus (HPV-16/18)
- HSIL:
-
High-grade squamous intraepithelial lesion
- LEEP:
-
Loop electrocautery excisional procedure
- LSIL:
-
Low-grade squamous intraepithelial lesion
- NILM:
-
Negative for intraepithelial lesion or malignancy
- SCC:
-
Squamous cell carcinoma
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Acknowledgements
The project described was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR002373. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
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SMP: Protocol development, data collection, data analysis, manuscript writing. AJJ: Protocol development, data collection, manuscript writing
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This study was approved by the University of Wisconsin with IRB number 2018–1135. There was no funding source for this project. Neither author has any conflicts of interest.
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Approved by University of Wisconsin with IRB number 2018–1135.
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Peace, S.M., Jennings, A.J. Prevalence of high-grade dysplasia in cytology-negative, HPV-positive cervical cancer screening. Arch Gynecol Obstet 305, 87–93 (2022). https://doi.org/10.1007/s00404-021-06208-2
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DOI: https://doi.org/10.1007/s00404-021-06208-2